DOWN SYNDROME & DISABILITY BENEFITS
WHAT IS DOWN SYNDROME?
Down syndrome is a genetic condition in which a person is born with an extra chromosome. Typically, a baby is born with 46 chromosomes. However, babies with Down syndrome have an extra copy of chromosome 21. The medical term for having an extra copy of a chromosome is ‘trisomy.’ Therefore, another name for Down syndrome is Trisomy 21.
Down syndrome cannot be cured. It is also the most common genetic condition found in the United States. Each year, about 6,000 babies born in the United States are born with Down syndrome. When you are born with Down syndrome, it changes the way your body and brain develop. It can also cause mental and physical challenges throughout your life. In 1983, the life expectancy of a person with Down syndrome was only 25 years. However, due to medical advances, now the average life expectancy is 60 years old.
WHAT CAUSES DOWN SYNDROME?
While doctors don’t know what causes the syndrome. They do know that women who are over 35 years old have a higher chance of having a baby with Down syndrome. There are two main ideas about why this happens. One theory says that all women have some eggs with an extra chromosome and that these eggs are more likely to be used at the end of a woman’s reproductive life. In other words, when the mother is older than 35.
The other theory suggests that the rate of trisomic conception is the same at all maternal ages, but that pregnancy is less likely to end in miscarriage in older women. The idea is that the body of the mother recognizes that a late pregnancy is perhaps the last or only one. Therefore, her body tries harder to make sure the pregnancy come to term.
COMMON FEATURES THAT OCCUR IN PEOPLE WITH DOWN SYNDROME
People with Down syndrome are all very different from each other. This is true in terms of appearance, ability, and personality. However, there are some shared characteristics that do occur in people with Down syndrome. The following lists some of those shared features.
Most people with Down syndrome share some common physical features. Although not every person with the condition these features. The most common physical features of Down syndrome are:
- A flattened face, especially at the bridge of the nose
- Almond-shaped eyes
- A short neck
- Small ears
- Small hands and feet
- A small mouth which makes the tongue seem slightly large
- Small white spots on the iris of the eye
- A single line across the palm of the hand
- Small pinky fingers
- Poor muscle tone and possibly lose joints
- A below average birth weight and length at birth
COMMON HEALTH PROBLEMS
Certain health problems are more common in people with Down’s syndrome. Because of advances in medical care most of these problems can be treated. These problems include:
- Almost half of Down syndrome babies are born with heart problems, many of which require heart surgery
- Hearing and sight problems
- Thyroid disorder
- Poor immune system
- Respiratory problems
- Obstructed gastrointestinal tract
People with Down syndrome have many differences in their cognitive abilities. However, early intervention and education does result in higher developmental scores. Individuals with Down syndrome have:
- delay in cognitive development
- specific deficits in speech, language and auditory short-term memory
- higher risk for Depression and Alzheimers disease
If you child is born with low birth weight or has developmental delay, then you can learn more about childhood SSI benefits here.
WHAT ARE THE TREATMENT OPTIONS FOR DOWN SYNDROME?
Early treatment often helps babies and children with Down syndrome. Most early treatment focuses on helping children with Down syndrome develop to their full potential. These services include:
- Physical, occupational, and speech therapy
- Specialized education services, tutoring, and teaching assistants
- Social and recreational activities
- Programs that offer job training and teach self-care skills
IS DOWN SYNDROME A DISABILITY?
WHAT IS THE DIFFERENCE BETWEEN NON-MOSAIC AND MOSAIC DOWN SYNDROME?
Although Down syndrome exists in non-mosaic and mosaic forms, the SSA only considers non-mosaic Down syndrome under their rules. The only way of finding out what type of Down’s syndrome people have is to do a blood test and examine their chromosomes under a microscope.
NON-MOSAIC DOWN SYNDROME
Non-mosaic Down syndrome is a genetic condition. Most people with non-mosaic Down syndrome have three copies of chromosome 21 in all of their cells. Some have an extra copy of chromosome 21 attached to a different chromosome in all of their cells. This is known as chromosome 21 translocation. People with non-mosaic Down syndrome have facial or other physical features of Down syndrome. They also have delayed physical development and intellectual problems. People with non-mosaic Down syndrome can also have congenital heart disease, vision problems, and hearing issues. If you have non-mosaic Down syndrome, the SSA should pay you benefits from birth. However, you will still need to apply for benefits in order to get them.
MOSAIC DOWN SYNDROME
Approximately 2 percent of people with Down syndrome have the mosaic form. In the mosaic form, there are some cells with an extra copy of chromosome 21 and other cells with the normal two copies of chromosome 21. It is possible for the Mosaic form to not show up on testing. However, it can still be severe, due to the affects it has on various body systems.
MEETING LISTING 10.06 FOR NON-MOSAIC DOWN SYNDROME
In order to win benefits, you must meet SSA listing 10.06. Listing 10.06 has the SSA’s rules to prove disability for non-mosaic Down syndrome. The listing is as follows:
10.06 Non-mosaic Down syndrome, (chromosome 21 trisomy or chromosome 21 translocation), documented by:
A. A laboratory report of karyotype analysis signed by a physician, or both a laboratory report of karyotype analysis not signed by a physician and a statement by a physician that you have Down syndrome.
B. A physician’s report stating that you have chromosome 21 trisomy or chromosome 21 translocation consistent with prior karyotype analysis with the distinctive facial or other physical features of Down syndrome.
C. A physician’s report stating that you have Down syndrome with the distinctive facial or other physical features and evidence demonstrating that you function at a level consistent with non-mosaic Down syndrome.
WHAT MEDICAL EVIDENCE DO YOU NEED UNDER LISTING 10.06?
Under 10.06B, the SSA needs medical evidence from a physician stating:
(i) your karyotype diagnosis or evidence that documents your type of Down syndrome is consistent with prior karyotype analysis (for example, reference to a diagnosis of “trisomy 21”), and
(ii) that you have the facial or other physical traits of Down syndrome.
The SSA does not require a description of the facial or other physical traits of the condition. However, they will not find that your disorder meets 10.06B if there is evidence that is inconsistent with the diagnosis.
If the SSA does not have evidence of prior karyotype analysis, because you did not have testing or you had testing but do not have the test results, then they can still find you meet listing 10.06 under certain conditions. The SSA will find that your disorder meets 10.06C if you can provide:
(i) a report from a doctor stating that you have the facial or other physical traits of Down syndrome, and
(ii) evidence that your functioning is consistent with a diagnosis of non-mosaic Down syndrome.
This evidence may include medical or other information about your physical and mental conditions. For example, it can include information about your education and work history. It can also include the results of mental testing. However, the SSA will not find that your disorder meets 10.06C if there is evidence—such as evidence of functioning inconsistent with the diagnosis—that indicates that you do not have non-mosaic Down syndrome.
QUALIFYING FOR DISABILITY BENEFITS FOR MOSIAC DOWN SYNDROME
The SSA does not have a specific listing for mosaic Down syndrome, even though the two conditions share many of the same physical symptoms. According to the SSA, mosaic Down syndrome alone is not enough to qualify for benefits.
If you have mosaic Down syndrome, then the SSA requires you to prove your physical or mental conditions prevent you from working. The SSA will consider the mosaic form under the listing that fits the symptoms of the closest physical or mental conditions. Some common SSA rules that a person with mosaic Down syndrome might equal include:
- congenital heart disease
- sleep apnea
- hearing loss, as found with recurrent ear infections
- intellectual disability or low IQ
In addition, for adults who don’t meet a listing, Social Security will assess what their ability to work using their residual functional capacity.
SSA’S LISTING FOR A CHILD WITH NON-MOSAIC DOWN SYNDROME
Since Down syndrome is a condition from birth, you may be wondering what listing the SSA uses to pay benefits. The listing for childhood benefits is the same as that of an adult. SSA’s childhood listing is under Listing 110.06. Below you will find listing 110.06.
110.06 Non-mosaic Down syndrome (chromosome 21 trisomy or chromosome 21 translocation) with:
A. A laboratory report of karyotype analysis signed by a physician, or both a laboratory report of karyotype analysis not signed by a doctor and a statement by a doctor that the child has Down syndrome.
B. A physician’s report stating that the child has chromosome 21 trisomy or chromosome 21 translocation consistent with karyotype analysis with the distinctive facial or other physical features of Down syndrome.
C. A physician’s report stating that the child has Down syndrome with the distinctive facial or other physical features and evidence demonstrating that the child is functioning at the level of a child with non-mosaic Down syndrome.
As you can see, the listing for children is just like the listing for adults. Therefore, the medical evidence needed to prove you deserve benefits is also the same. In short, the SSA will rely on medical evidence from your doctor. If you have a child with Down syndrome, then have your doctor submit medical proof of the condition to the SSA. This will require SSA to grant your benefits.
QUALIFYING FOR SUPPLEMENTAL SECURITY INCOME (SSI) BENEFITS FOR DOWN SYNDROME
Most people who are applying for disability benefits for Down syndrome will be applying for SSI benefits. SSI benefits are specifically for people who have never worked or have worked very little in their lives. SSI benefits, or Supplemental Security Income benefits, are exactly what they say they are; an add-on. In other words, SSI adds to your income or to your SSD benefit if it is low.
In order to win SSI benefits, you must have a condition that meets SSA’s list. Next, you must meet the income and asset rules set by the SSA. SSI benefits give you income to bring you to a certain standard of living when you have a condition that keeps you from working.
Additionally, SSI benefits are a set amount of money each month. Each state sets the amount of SSI for its’ citizens. The monthly amount is the same for every citizen who lives in that state. Typically, if you win SSI benefits, then you also qualify for Medicaid. Find out more information about Medicaid benefits here.
If you are a parent who gets SSI benefits for your child with Down syndrome, then you need to learn about the special rules that apply to representative payees. The blog on this website can answer most of your questions. Read our article about being a representative payee and your benefits.
WHAT WE DO TO HELP YOU WITH YOUR DISABILITY CASE
There is some good news. You do not need to obtain Social Security benefits for Down syndrome on your own. Cannon Disability Law can help file your disability application. Also, we can help you file an appeal at each stage of the process. That way, you can focus on your health and living your life. Our attorneys and staff can:
- Send you the paperwork you need to become our client
- Help you file your application for SSD and SSI benefits
- Request reconsideration if you receive an initial denial from Disability Determination Services
- Help you confirm your attendance at a Consultative Examination
- Request a Hearing with an Administrative Law Judge (ALJ)
- Prepare you to be a good witness at your SSA hearing
- Represent you at your hearing and question the vocational and medical expert witnesses.
- Read more about vocational expert testimony here.
- Learn more about medical expert testimony here.
- Request review of an unfavorable decision with the Appeals Council
- Request review of an Appeals Council denial in Federal Court
If you file your application for disability benefits online at Social Security’s website, then you have 6 months to complete the application. Once you submit your online application, the SSA sends you an application summary in the mail. You must sign the summary and mail it back. Additionally, once you receive a denial from the SSA, you have 60 days to file an appeal. You must meet the time limit set by the SSA. If you do not, then you will have to start the process over again. That means you will lose any benefits you could receive on the old application.
HIRE CANNON DISABILITY AND PUT OUR EXPERIENCE TO WORK FOR YOU
In the past 30 years, we have won millions of dollars in benefits for our clients. If you want to win benefits, then you need to hire an attorney with the experience to win your case. You should ask any attorney you are thinking of hiring about how many SSD and SSI cases they have won. If the answer is less than 100, they don’t have enough experience to win your case. Especially if you have a complex medical condition. You need a lawyer to show the SSA that they should pay you benefits. We can do that. Contact us today.
If you want to learn more about Cannon Disability’s representatives, then read our About Us page. For instance, Andria Summers is an amazing advocate. She can help you with your Medicare plan. She has also won thousands of SSD and SSI cases. Dianna Cannon has been a lawyer for thirty years. Brett Bunkall also has significant experience helping people obtain their SSI and SSD benefits. We are experts. You can trust us to help you win benefits.
In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Also, we help our clients with their Medicare benefits. Our specialists can help you apply for disability benefits using the SSA’s website.
Likewise, if you need an appeal, we can help you with that too. There are also many forms you will need to fill out. But, don’t worry. If you have questions about these forms, then we will answer them. You can learn more about SSA’s appeal forms here. Call us for a free review of your case or your child’s Down syndrome case today.